Billing Compliance Analyst at The University of Kansas Health System in Kansas City, Kansas

Job Description:

Billing Compliance Analyst

Department

Billing Compliance

Shift

Days - Full-Time

Requisition ID

2020-27259

Position Location

Work at Home Kansas

City

Kansas City

Category

Professional: Non-Clinical

State

Kansas

Position Summary/Career Interest

We are currently seeking a Billing Compliance Analyst in our Audit Compliance Department.

Responsibilities

Demonstrates competence in the areas of critical thinking, interpersonal relationships, and technical skills.
- Demonstrates ability to provide care/service safely and efficiently for the care of each patient.
- Effectively uses the appropriate financial concepts and tools to analyze situations and make financial decisions that support the achievement of short and longer-term departmental objectives.
- Complies with Medicare/Medicaid rules and regulations.
- Assists Director, Manager, and Coordinator of Billing Compliance in organizing and implementing compliance initiatives related to Hospital billing in accordance with rules, regulations, laws and payer contractual requirements.
- Functions as the primary resource for clinical departments requesting addition of new charge codes for hospital services, identifies and researches associated compliance risks, and makes recommendations to the Chargemaster Coordinator / Manager of Billing Compliance regarding exceptional requests (including investigational and high cost items).
- Researches coding, coverage, medical necessity and other compliance issues for all payers related to new charges added to the charge master.
- Educates clinical departments on the Charge Master maintenance process, assists with completion of requisite forms, assigns General Ledger and Insurance codes, transmits approved CDM maintenance forms to HIS for input into SMS and O2, and communicates completion of process back to clinical departments.
- Assumes primary responsibility for insuring that all necessary ongoing maintenance to the Charge Description Master is completed in response to annual coding updates and periodic Medicare bulletins, newsletters and revisions to National and Local Medical Review Policies.
- Serves as primary resource to Patient Financial Services staff for reporting problems and denials on individual claims. Researches coding issues and recommends solution to account representative. Identifies source of problem and implements corrective action to insure that Charge Master is updated to prevent future rejections/denials and to insure accurate and expedient reimbursement.
- Completes routine claim audits and transaction testing to insure regulatory billing compliance and to support departmental compliance initiatives.
- Assists with the review and response to external governmental audits, including those from our Medicare Administrative Contractor, Recovery Audit Contractor, Medicaid Integrity Program, and the Office of Inspector General.
- Prepares and monitors reports intented to prevent and correct charge capture and coding compliance issues.
- Serves as liaison between Finance and Charge Audit Nurse (Internal Audit) to inform of changes in Charge Master and charging protocol in clinical departments.
- Serves on compliance committees as requested by Director.
- Monitors WPS and CMS for updates to Local and National Coverage Determination Policies. Coordinates comment letters for draft policies. Communicates changes to policies to the relevant clinical and financial personnel.
- Performs reviews and appeals of claims with Medical Necessity edits.
- Facilitates the maintenance of medical necessity edits and pathways in Healthworks and O2 order entry pathways.
- Demonstrates knowledge of the mainframe systems, O2 and SMS pathways, Excel and Word.
- Maintains a high level of involvement in the day to day activities related to areas of responsibility. Provides leadership presence and guidance through direction and role modeling.
- Maintains an Open Issues Log and reviews with Director of Billing Compliance at regularly scheduled meetings to secure needed assistance in resolving issues and to promote accountability.
- Immediately reports compliance issues to the responsible Manager and Director of Billing Compliance and assists with the development of a corrective action plan.
- Attends and actively participates in training and education to increase knowledge and professional growth within this position.

Qualifications

Required:
- Bachelors degree in Business or Nursing or Eight years of relevant experience will be considered in lieu of the Bachelor Degree requirement
- Minimum of three years experience in Hospital Billing, Medical Records or Charge Audit environment.
- Demonstrated general knowledge of billing and coding rules and regulations for governmental and managed care payers. Experience with coding and Charge Description Master maintenance is desirable
Preferred:
- Technical/Professional Training/Degree in Business, Med Records Coding, Nursing,or IT

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We are an equal employment opportunity employer without regard to a person s race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.